PMID- 36519188 OWN - NLM STAT- MEDLINE DCOM- 20230809 LR - 20230814 IS - 1497-0015 (Electronic) IS - 0706-7437 (Print) IS - 0706-7437 (Linking) VI - 68 IP - 8 DP - 2023 Aug TI - Effects of Buprenorphine/Naloxone and Methadone on Depressive Symptoms in People with Prescription Opioid Use Disorder: A Pragmatic Randomised Controlled Trial. PG - 572-585 LID - 10.1177/07067437221145013 [doi] AB - OBJECTIVE: This study aimed to evaluate the effectiveness of flexible take-home dosing of buprenorphine/naloxone (BUP/NX) and methadone standard model of care in reducing depressive symptoms in people with prescription-type opioid use disorder (POUD). This trial also evaluated whether improvements in depressive symptoms were mediated by opioid use. METHODS: Analyzed data came from the OPTIMA study (clinicaltrials.gov identifier: NCT03033732), a pragmatic randomised controlled trial comparing flexible take-home dosing of BUP/NX and methadone standard model of care for reducing opioid use in people with POUD. A total of 272 participants were recruited in four Canadian provinces. Participants were randomised 1:1 to BUP/NX or methadone. After treatment induction, past two-week opioid use was measured using the Timeline Followback every two weeks for a total of 24 weeks. Depressive symptoms were measured with the Beck Depression Inventory at baseline, weeks 12 and 24. RESULTS: Both BUP/NX and methadone significantly reduced depressive symptoms at week 12 (abeta +/- SE = -3.167 +/- 1.233; P < 0.001) and week 24 (abeta +/- SE = -7.280 +/- 1.285; P < 0.001), with no interaction between type of treatment and time (P = 0.284). Improvements in depressive symptoms were only partially mediated by a reduction in opioid use (proportion mediated = 36.8%; 95% confidence interval = -1.158 to -0.070; P = 0.015). CONCLUSIONS: BUP/NX and methadone showed similar effectiveness in decreasing comorbid depressive symptoms in people with POUD. This effect was partially explained by a reduction in opioid use. As both treatments seem equally effective, clinicians are encouraged to tailor the selection of OAT to patients' needs and characteristics. FAU - Bastien, Gabriel AU - Bastien G AUID- ORCID: 0000-0002-7969-9998 AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. FAU - McAnulty, Christina AU - McAnulty C AUID- ORCID: 0000-0003-2787-2792 AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. FAU - Ledjiar, Omar AU - Ledjiar O AD - Unite de recherche clinique appliquee, Centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada. FAU - Socias, M Eugenia AU - Socias ME AD - British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. AD - Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Le Foll, Bernard AU - Le Foll B AD - Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada. AD - Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. AD - Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. AD - Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada. FAU - Lim, Ron AU - Lim R AD - Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. FAU - Hassan, Ahmed N AU - Hassan AN AD - Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada. AD - Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. FAU - Brissette, Suzanne AU - Brissette S AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Marsan, Stephanie AU - Marsan S AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Talbot, Annie AU - Talbot A AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. AD - Department of Family and Emergency Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. FAU - Jutras-Aswad, Didier AU - Jutras-Aswad D AUID- ORCID: 0000-0002-8474-508X AD - Department of Psychiatry and Addictology, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada. AD - Research Centre, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada. CN - OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse LA - eng SI - ClinicalTrials.gov/NCT03033732 GR - CIS-144301/CIHR/Canada GR - CIS-144302/CIHR/Canada GR - CIS-144303/CIHR/Canada GR - CIS-144304/CIHR/Canada GR - SMN-139148/CIHR/Canada GR - SMN-139149/CIHR/Canada GR - SMN-139150/CIHR/Canada GR - SMN-139151/CIHR/Canada PT - Journal Article PT - Pragmatic Clinical Trial PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20221214 PL - United States TA - Can J Psychiatry JT - Canadian journal of psychiatry. Revue canadienne de psychiatrie JID - 7904187 RN - UC6VBE7V1Z (Methadone) RN - 0 (Analgesics, Opioid) RN - 40D3SCR4GZ (Buprenorphine) RN - 0 (Narcotic Antagonists) RN - 0 (Buprenorphine, Naloxone Drug Combination) SB - IM MH - Humans MH - Methadone/therapeutic use MH - Analgesics, Opioid/therapeutic use MH - Depression/drug therapy MH - *Buprenorphine/therapeutic use MH - Narcotic Antagonists/therapeutic use MH - Opiate Substitution Treatment MH - Canada/epidemiology MH - Buprenorphine, Naloxone Drug Combination/therapeutic use MH - *Opioid-Related Disorders/drug therapy MH - Prescriptions PMC - PMC10411362 OTO - NOTNLM OT - comorbidity OT - depressive disorders OT - dual diagnosis OT - major depressive disorder OT - randomised controlled trial OT - substance use disorders COIS- The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. EDAT- 2022/12/16 06:00 MHDA- 2023/08/09 06:43 PMCR- 2022/12/14 CRDT- 2022/12/15 02:40 PHST- 2023/08/09 06:43 [medline] PHST- 2022/12/16 06:00 [pubmed] PHST- 2022/12/15 02:40 [entrez] PHST- 2022/12/14 00:00 [pmc-release] AID - 10.1177_07067437221145013 [pii] AID - 10.1177/07067437221145013 [doi] PST - ppublish SO - Can J Psychiatry. 2023 Aug;68(8):572-585. doi: 10.1177/07067437221145013. Epub 2022 Dec 14.